A Service Model For Delivering Care Closer to Home.

Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient. This is a practical example of early implementation of the principles underlying the Department of Health’s (DH) recent Best Practice Guidance, ‘Delivering Care Closer to Home’ (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the ‘Customer Care’ award by ‘Management in Practice’. The Surgery was also awarded the ‘Practice of the Year’ award for this and a number of other customer-focussed projects.

Generative Divergent Analysis as a Model for Reflection Illustrated with Reference to an Early-years Reception Class and Wicker Settee

Generative divergent analysis (GDA) is a creative additive approach to raising insignificant details of experience to significance. A schematic view of the model highlights use of evocative objects as starting point for ‘turning towards’, ‘turning away’ and ‘being-in-relation-to’ as part of an ongoing burgeoning of experience.The model is exemplified by focusing on a wicker settee as an evocative object that was noticed in an early-years reception class. Revisiting the object generated several speculative ideas relating to the hidden curriculum and energies of childhood. Poetry and song were used during the revisiting in order to develop a more direct experience in addition to the more contemplative awareness that was evoked during the first encounters. As an additive process the outcome of GDA takes the form of unfinished resources for thinking.

Variation of the Group 5 Grass Pollen Allergen Content of Airborne Pollen in Relation to Geographical Location and Time in Season

Allergies to grass pollen are the number one cause of outdoor hay fever. The human immune system reacts with symptoms to allergens from pollen. Objective: We investigated the natural variability in release of the major group 5 allergen from grass pollen across Europe. Methods: Airborne pollen and allergens were simultaneously collected daily with a volumetric spore trap and a high-volume cascade impactor at 10 sites across Europe for 3 consecutive years. Group 5 allergen was determined with a Phl p 5 specific ELISA in two fractions of ambient air: Particulate Matter (PM) >10μm and 10μm>PM>2.5μm. Mediator release by ambient air was determined in FcεR1-humanized basophils. Origin of pollen was modeled and condensed to pollen potency maps. Results: On average grass pollen released 2.3 pg Phl p 5/pollen. Allergen release per pollen (potency) varied substantially, ranging from 0 to 9 pg Phl p 5/pollen (5 to 95% percentile). The main variation was locally day-to-day. Average potency maps across Europe varied between years. Mediator release from basophilic granulocytes correlated better with allergen/m3 (r2=0.80, p<0.001) than with pollen/m3 (r2=0.61, p<0.001). In addition, pollen released different amounts of allergen in the nonpollen bearing fraction of ambient air depending on humidity. Conclusion: Across Europe, the same amount of pollen released substantially different amounts of group 5 grass pollen allergen. This variation in allergen release is on top of variations in pollen counts. Molecular aerobiology, i.e. determining allergen in ambient air, may be a valuable addition to pollen counting.

Mesoscale Atmospheric Transport of Ragweed Pollen Allergens from Infected to Uninfected Areas

Allergenic ragweed (Ambrosia spp.) pollen grains, after being released from anthers, can be dispersed by air masses far from their source. However, the action of air temperature,humidity and solar radiation on pollen grains in the atmosphere could impact on the ability of long distance transported (LDT) pollen to maintain allergenic potency. Here, we report that the major allergen of Ambrosia artemisiifolia pollen (Amb a 1) collected in ambient air during episodes of LDT still have immunoreactive properties. The amount of Amb a 1 found in LDT ragweed pollen grains was not constant and varied between episodes. In addition to allergens in pollen sized particles, we detected reactive Amb a 1 in subpollen sized respirable particles. These findings suggest that ragweed pollen grains have the potential to cause allergic reactions, not only in the heavily infested areas but, due to LDT episodes, also in the regions unaffected by ragweed populations.

Omega-3 Fatty Acids are Related to Abnormal Emotion Processing in Adolescent Boys with Attention Deficit Hyperactivity Disorder

Background In addition to the core symptoms, attention deficit hyperactivity disorder (ADHD) is associated with poor emotion regulation. There is some evidence that children and young adults with ADHD have lower omega-3 levels and that supplementation with omega-3 can improve both ADHD and affective symptoms. We therefore investigated differences between ADHD and non-ADHD children in omega-3/6 fatty acid plasma levels and the relationship between those indices and emotion-elicited event-related potentials (ERPs). Methods Children/adolescents with (n=31) and without ADHD (n=32) were compared in their plasma omega-3/6 indices and corresponding ERPs during an emotion processing task. Results Children with ADHD had lower mean omega-3/6 and ERP abnormalities in emotion processing, independent of emotional valence relative to control children. ERP abnormalities were significantly associated with lower omega-3 levels in the ADHD group. Conclusions The findings reveal for the first time that lower omega-3 fatty acids are associated with impaired emotion processing in ADHD children.